Apply for the 2023-2024 Helen Watson Buckner Scholarship

APPLICANT'S INFORMATION

Name:

First

Last

Date of Birth:

Address

Address Line 1

Address Line 2

City

State

Zip Code

Sex:

Email:

Parent's Name #1

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Parent's Name #2 *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone

Siblings (If Applicable. List by Name, Age, School)

BRICK CHURCH AFFILIATION

Are you a member of The Brick Presbyterian Church? Describe the duration and extent of your involvement.

ACADEMIC INFORMATION

School you currently attend:

School address:

Your current grade:

Dates of attendance at this school:

Previous school:

School you plan to attend next academic year:

Academic honors:

Extracurricular interests:

What degree or certificate will you be working toward in the next academic year? Have you declared a major (if in college)?

FAMILY FINANCIAL INFORMATION

Parent #1:

Occupation

Current employer

Length of employment

Salary

Parent #2:

Occupation

Current employer

Length of employment

Salary

Expenses

Please indicate any current or anticipated significant expenses, including:

Elderly relatives at home

Yes
No

Medical Expenses

Yes
No

APPLICANT’S FINANCIAL INFORMATION

Please list your anticipated expenses for next academic year (tuition, room, board, books, travel, etc.).

Do you expect this aid to continue in the next academic year?

Yes
No

Are you applying for other scholarship funds or financial aid for next academic year?

Yes
No

Please describe:

Have you worked during the school year or during the summer to earn money for your education? Please describe your employment and earnings.

Are you receiving any financial aid this current academic year?

Yes
No

Please upload all supporting documents including: An official school transcript from your most recent academic year, and a letter of recommendation from a teacher/professor/coach at your current school.

Click or drag a file to this area to upload.

The Women’s Association reserves the right to ask for further information.

Submitted by:

Signature of Applicant

Date